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Section 12
Body Image Acceptance

Question 12 | Test | Table of Contents

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In the last section, we discussed watching worries come and go.  Regarding watching worries come and go, three techniques we discussed were tracking anxiety levels, journaling, and focusing on positive aspects of life. 

In this section, we will discuss mirror anxiety.  This section will focus on body image, discovering the good, and the Cognitive Behavior Therapy technique of thought capturing.  As you read this section, you might consider playing it for a client you are treating.

♦ Body Image
As you know, when it comes to anxiety, fear, and shame, your client’s body may be a trigger.  How it looks, how it functions, how it feels, how it has been cared for or violated, how it is changing, or how long it will keep on working are all thoughts which may impact how your client feels about his or her body. 

Appearance goes way beyond our immutable physical characteristics.  Our attractiveness to others is powerfully influenced by our confidence, warmth, character, intelligence, personality, spirit, and style.  How a woman feels about herself comes through. The fact that Lori felt so negatively about herself certainly affected how others respond to her.  But even more to the point, Lori’s negative, self-deprecating perception of how she looked wasn’t good for her.
Lori, age 41, needed to do the best with what she had and move on.  It was not easy for her to accept and love herself when she felt so bad about her appearance, but by staying over-focused on her appearance, she stayed under-focused on other important issues.  Think of your Lori.  Does anxiety regarding one issue prompt your client to ignore other issues?

♦ Discovering the Good
I responded to Lori with some hard questions: What talents and abilities does she want to develop over the next few years?  What are her work and career goals?  What are her values and beliefs about being a good sister, daughter, aunt, or cousin?  What connections does she have in her neighborhood and community?  What is the importance of friendship in her life?  Does she take good care of herself?  What sort of home does she want to create for herself?  Is she living healthfully?  What brings her pleasure or joy?  Is she being useful to others?  Regarding feelings of usefulness, would you agree that being useful to others may be one of the greatest antidotes to the pain of self-absorption for anxiety clients?

♦ CBT Technique:  Thought Capturing
After several therapy sessions with Lori, it became apparent that her anxiety was triggered by a poor self-image.  Clearly, Lori’s thoughts were powerfully influencing her emotions.  Events such as a bad hair day may serve as a trigger, but these events are not what lead to anxiety.  Rather, anxiety is a result of the meaning behind the event.  Lori’s thoughts reflected that meaning and led to anxiety.

For example, Jim’s wife was 45 minutes late coming home from work.  Jim’s anxiety levels rose, leading him to think anxious thoughts such as "Maybe she’s had an accident" or "She’s probably having an affair."  Think of your Jim.  How can you influence your client to have different thoughts that don’t cause so much anxiety?  Thoughts that don’t cause so much anxiety might be "I love spending time alone with the kids" or "Traffic must be bad tonight."

As you know, by capturing thoughts, clients like Jim and Lori can see how those thoughts trigger anxiety and connect to their feelings.  If you’re client is not sure what thoughts are triggering anxiety, thought capturing can be a productive method of identifying those triggers. 

I stated to Jim, "First, focus on the anxiety trigger.  Think about it for a while.  Don’t rush it."  Jim focused on his anxiety trigger, which was his wife coming home late, until he felt his anxiety levels rise.  I then asked Jim some questions about his triggers.  For example, I asked "Specifically, what about your wife coming home late do you find upsetting?"  Jim responded, "Well, she’s a real big part of my life, so I guess I’m worried about her." 

What other thought capturing questions could I have asked Jim to help identify the meaning behind his anxiety?  How might you adapt the questions to focus on mirror anxiety?

♦ Capturing Leah's Thoughts
Do you remember Leah from the first section?  Leah suffered physical effects of anxiety prior to taking tests in college.  Let’s review some of Leah’s answers to a line of questioning when I implemented thought capturing with her.  
1. One question I asked was, ‘‘What’s the worst that could happen?"  Leah stated, "I could fail the test and my boss would find out." 
2. Next, I asked, "How might this event affect the way others see you?"  Leah answered, "My boss and coworkers will know how stupid I am." 
3. Another question which helped identify Leah’s true feelings was "How might the test affect the way you see yourself?"  Leah’s response was, "If I fail, I’ll finally know for sure that I’m the loser I always thought I might be!"

Even though earlier, Leah could not explain why tests made her so anxious, answering thought capturing questions brought her hidden thoughts about the test taking to light.  What was Leah’s anxiety trigger?  What was the meaning behind that trigger?  How could thought capturing work for your client?

In this section, we discussed mirror anxiety.  This section focused on body image, discovering the good, and the technique of thought capturing. 

In the next section, we will discuss managing anxiety with humor.  We’ll examine how humor helps, using humor to cope with anxiety, the Playing with Language technique, and increasing a client’s capacity for humor.

- Della Sala, S., Calia, C., De Caro, M. F., & McIntosh, R. D. (2015). Transient involuntary mirror writing triggered by anxiety. Neurocase (Psychology Press), 21(5), 665-673.
- Blom, E. C., Serlachius, E., Larsson, J., Theorell, T., & Ingvar, M. (2010). Low Sense of Coherence (SOC) is a mirror of general anxiety and persistent depressive symptoms in adolescent girls - a cross-sectional study of a clinical and a non-clinical cohort. Health and Quality of Life Outcomes, 8(1), 58-70. doi:10.1186/1477-7525-8-58
Reviewed 2023

Peer-Reviewed Journal Article References:
Linardon, J., Messer, M., Lee, S., & Fuller-Tyszkiewicz, M. (2019). Testing the measurement invariance of the Body Image Acceptance and Action Questionnaire between women with and without binge-eating disorder symptomatology: Further evidence for an abbreviated five-item version.Psychological Assessment, 31(11), 1368–1376. 

Pellizzer, M. L., Tiggemann, M., Waller, G., & Wade, T. D. (2018). Measures of body image: Confirmatory factor analysis and association with disordered eating. Psychological Assessment, 30(2), 143–153.

Ryding, F. C., & Kuss, D. J. (2019). The use of social networking sites, body image dissatisfaction, and body dysmorphic disorder: A systematic review of psychological research. Psychology of Popular Media Culture.Advance online publication.


What is a CBT technique which can be implemented to help clients identify thoughts or the meaning behind specific events that contribute to anxiety? To select and enter your answer go to Test.

Section 13
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